Supporting Work without the Requirement: State and Managed Care Initiatives

Executive Summary

The Centers for Medicare and Medicaid Services (CMS) continues to promote state adoption of work and reporting requirements as a condition of Medicaid eligibility for certain nonelderly adults, although several such waivers have been set aside by federal courts. While most Medicaid adults are already working, some states and health plans have developed voluntary work support programs for nonelderly adults who qualify for Medicaid through non-disability pathways. These programs offer services that support work without conditioning Medicaid eligibility on having a job. This brief examines opportunities for and limitations on federal and state support of such programs, highlights several state and health plan initiatives, and explores their common themes. Key findings include the following:

• Medicaid supports employment by providing affordable health coverage, which helps low-wage workers get the care they need to remain healthy enough to work. Beyond providing coverage, state Medicaid programs have limited flexibility to provide services that support work for nonelderly Medicaid adults eligible through non-disability pathways.
• Montana’s HELP-Link program provides a leading example of a voluntary employment support program for enrollees who qualify through non-disability pathways. HELP-Link uses screening, employment, and referral services to identify participant goals and needs and connect them to appropriate resources. (Montana has also submitted a proposed waiver for a work requirement; implementation has been delayed.) On a smaller scale than Montana, Louisiana has taken a local approach, developing a pilot program to link targeted Medicaid expansion enrollees with work training programs at a local community college, and Maine has chosen to emphasize existing vocational training and workforce supports. Some of these states have devoted new state resources to these programs, but no state has received new federal Medicaid funds specifically for their operation.
• Medicaid managed care plans can take steps to link their members with employment resources. One health plan that provides its members with direct employment assistance is CareSource, which operates the JobConnect program in Georgia, Indiana, and Ohio.
• These state and plan programs share common features, including customization to locality; a focus on identifying individuals who are not working but currently are in a position to work, and then addressing their barriers to employment; state coordination across agencies and with community-based organizations; and high-touch referrals and follow-up with participants.
• Looking ahead, it will be important to evaluate the effects of existing voluntary work support programs on enrollee participation and employment rates and to identify common elements of success and key challenges as well as costs needed to administer a successful program. As work requirements continue to face litigation, and research shows limited gains in employment from such requirements, voluntary programs that support work and can be implemented without waiver authority could provide another option for states interested in supporting employment for enrollees who qualify through non-disability pathways.